Guide

“Summer heat that makes the skin feel flushed can bring out melasma, hyper-pigmentation and rosacea,” Dr. Simon Ourian adds. “And humidity, which is usually good for dry skin, can make conditions like Eczema worse." 7 Products That Will Instantly Save Dry Summer Skin, Emily Siegel, Forbes Here are seven of the products mentioned in the article above. If you purchase them through our Amazon Affiliate program the RRDi receives a small affiliate fee. Mahalo for purchasing through the RRDi. (1) emerginC - Sun 30+ (2) Mad Hippie Facial SPF (3) S.W. Basics 4 Ingredient Oil Serum (4) One Love Vitamin D Mist (5) Ilia Cucumber Water Stick (6) Glow Recipe Watermelon Sleeping Mask (7) Osmia Organics Black Clay Facial Soap

People who suffer from rosacea can also develop broken capillaries. These capillaries aren't always necessarily broken, but blood vessels that have a rosacea-induced increase in production and open and close as a response to environmental and emotional factors. "This is what causes people with rosacea to feel excessively hot or flush," says Bashey. How to Get Rid of Broken Capillaries on Your Face, by Erin Lukas, InStyle, SheKnows

Edward S. Jarka, OD, MS explains: Brady, Thank you for this opportunity to weigh in on this topic. This is the way I would describe it to a patient: In the eye care world we are often faced with people who have uncomfortable eyes but no apparent signs to explain their discomfort. These patients typically complain of burning, grittiness or the feeling of something in their eyes and are told they have “dry eyes”, but after many appropriate treatments these people continue to feel discomfort. So…what’s causing this painful eye situation. Well, the sensation of pain is governed by a nerve called the Trigeminal Nerve. It has been speculated for some time that the reason for this eye pain was due to chronic inflammation of this Trigeminal Nerve. It was thought that the non-stop inflammation of this nerve changed the level of sensitivity of this nerve to be more sensitive to everyday sensations than normal. This condition is referred to as neurogenic inflammation. A condition which is hard to diagnose and often times even harder to treat. Rosacea is also a condition that is difficult to diagnose and difficult to treat. The Trigeminal Sensory Malfunction Theory suggests that an abnormal receptor in the skin known as TRPV4 functions abnormally. The TRPV4 receptor normally monitors an number of sensations such as vascular function and pain by regulating calcium to channel from one cell to another. So, The Trigeminal Sensory Malfunction Theory an initiating factor (abnormal chemical or mechanical cues) like non-stop inflammation → abnormal TRPV4 receptor → change in the level of sensitivity in the Trigeminal Nerve → Chronic pain not responsive to typical treatments of inflammation. The Trigeminal Sensory Malfunction Theory and the discovery of the role that the TRPV4 receptor might play in rosacea as well as certain types of dry eye may lead to early identification of the people at risk for rosacea, avoidance of the precipitating factors and treatments to modulate the function of the TRPV4 receptor. Does this work for you Brady? Thanks, Edward S. Jarka, OD, MS

"NYC-based dermatologist Dr. Dennis Gross sums it up like this: “Heavy metals (iron, copper, zinc, magnesium, and lead) are free radicals found in tap water, perspiration, and in an unbound form in skin. The heavy metals found in tap water are actually free radicals themselves. They also generate other free radicals (like a chain reaction) that destroy collagen.” The result, says Gross, is pandemonium for your skin — breaking down collagen, causing wrinkles and fine lines, inducing inflammation, and causing and aggravating conditions like acne and rosacea." Tap Water Could Be to Blame for Your Beauty Woes I mean, probably not all of them. BY MEGAN MCINTYRE, Racked

Flavia Addor, MD. explains: Rosacea is a chronic skin disease with a inflammatory disfunction that leads to vascular and cutaneous changes. A new theory seeks to explain the inflammatory component, and is liked to a dysfunction of a crianial nerve called trigeminal. Inflammation of this nerve would be linked to inflammation of the skin, increasing inflammatory mediators, substances that can act worsening the inflammation. On the other hand, external sensory stimuli would excite this nerve, triggering the vascular reactions known in rosacea, such as flush and burning.

Leonard Weinstock, MD wrote: Interesting This might explain why we have seen some patients get better with low dose naltrexone ... decreases inflammation

Received this explanation of the article in this thread from Ronald P. Drucker, B.S. (M.T.A.S.C.P), D.C., who wrote the following: Dear Brady Barrows: Glad you found me and thank you for your email. The gist of the research article to which you directed me is the following: Roseacea is a risk factor for Alzheimer's Disease (Type III Autoimmune Brain Diabetes). This is so because (even though the research article does not mention it), both are autoimmune diseases and anyone with one autoimmune disease is more likely to develop other ones. The next point of the article is that Inflammation of the Trigeminal Nerve can cause or exacerbate Rosacea and visa versa. This, of course, is due to the fact that all autoimmune diseases are accompanied by an exaggerated, defective immune response; namely chronic inflammation. Visit my website: www.healtherootcause.com, view any of the hundreds of successful User Reports . You can also read my book "The Code Of Life" with over 100 scientific references.

There is a new theory on the cause of rosacea, the Trigeminal sensory malfunction. So what is this all about? It involves the nervous system so it is subcategorized in the nervous system theory. First, the trigeminal nerve "is a nerve responsible for sensation in the face and motor functions such as biting and chewing and is the largest of the cranial nerves, Also, understanding what the Principal sensory nucleus of trigeminal nerve is all about, which is a "is a group of second order neurons which have cell bodies in the caudal pons," that "can result in craniofacial pain, including migraine, temporomandibular joint pain, and trigeminal nerve pain." [1] "The Mascarenhas et al. (2017) paper is exciting because it casts a critical element of rosacea pathogenesis in a new light. The increased presence of antibacterial cathelicidin is a hallmark of rosacea facial dermatitis." [1] The "link between chronic facial skin inflammation in rosacea, constitutive facial innervation by the trigeminal system, and possible involvement of trigeminal neuroinflammation and neural sensitization mechanisms in rosacea should prompt one to think more proactively about why the presence and severity of rosacea could act as a risk factor for Alzheimer's disease, as recently reported (Egeberg et al., 2016)." [1] "Trigeminal sensory malfunction in humans can result in craniofacial pain, including migraine, temporomandibular joint pain, and trigeminal nerve pain. As a functional and structural system that underpins these medically relevant conditions, the trigeminal system can generate neurogenic inflammation powerfully. Bearing in mind this important feature, we should consider whether the chronic facial dermatitis of rosacea can be facilitated by neurogenic inflammation via trigeminal sensory afferents and also whether chronically inflamed skin in rosacea can sensitize trigeminal sensory afferents. From the senior author's own clinical practice (with now >1,000 cases encountered suffering from trigeminally mediated pain and sensory disorders), the clinical impression is affirmative, as he has observed worsening of facial pain in patients with poorly controlled rosacea. Clearly, this clinical impression awaits controlled assessment through clinical studies." [1] TRPV4 "Mascarenhas et al. report that TRPV4 expression is upregulated in mast cells in response to the proteolytic cathelicidin fragment LL37 in a murine rosacea model and that TRPV4 loss of function attenuates mast cell degranulation. These findings render TRPV4 a translational-medical target in rosacea. However, signaling mechanisms causing increased expression of TRPV4 await elucidation. Moreover, we ask whether TRPV4-mediated Ca++-influx evokes mast cell degranulation." [1] "" 'Although more work needs to be done, these findings suggest that potential therapies may be developed specifically to block TRPV4 as a direct means of treating or preventing inflammation in patients with rosacea,' Dr. Di Nardo said." [2] Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] J Invest Dermatol. Author manuscript; available in PMC 2017 Jul 31. J Invest Dermatol. 2017 Apr; 137(4): 801–804.doi: 10.1016/j.jid.2016.12.013 - PMCID: PMC5536341-NIHMSID: NIHMS876146 TRPV4 Moves toward Center-Fold in Rosacea Pathogenesis Yong Chen, Carlene D. Moore, Jennifer Y. Zhang, Russell P. Hall, III, Amanda S. MacLeod, and Wolfgang Liedtke [2] Researchers Discover Missing Links in Rosacea Inflammation, NRS Posted: 08/14/2017

Arlene, Are you still around? Brady

I have now gone back to my tried and true favorite treatment, the ZZ cream which you can follow my photos and review here.

I have been using the ZZ cream for years. I stopped for a while to try Soolantra which I reviewed here. However, I have returned using the ZZ cream for about three weeks now and my face is doing much better using the ZZ cream which is my favorite treatment for rosacea along with my Rosacea Diet. So I thought I would post today my photos for your review. I haven't found anything as good as the ZZ cream to treat my rosacea/SD. Demodex Solutions is one of our affiliate sponsors.

The Huff Post has recently mentioned rosacea in an article, The Gut-Skin Axis: The Importance of Gut Health for Radiant Skin, by Deanna Minich, Ph.D., which is worthy of your consideration. We have more written on this subject with these posts/articles: Do You Have a Gut Feeling About Your Rosacea? Microbiome-based therapeutic strategies Probiotics Reply to this TopicThere is a reply to this topic button somewhere on the device you are reading this post. If you never heard about this topic and you learned about it here first, wouldn't it be a gracious act on your part to show your appreciation for this topic by registering with just your email address and show your appreciation with a post? And if registering is too much to ask, could you post your appreciation for this topic by finding the START NEW TOPIC button in our guest forum where you don't have to register? We know how many have viewed this topic because our forum software shows the number of views. However, most rosaceans don't engage or show their appreciation for our website and the RRDi would simply ask that you show your appreciation, please, simply by a post.

High magnification micrograph of cryptitis in a case of Crohn's disease (Image courtesy of Wikimedia Commons) Note: Is inflammatory bowel disease (IBD) the same thing as Irritable Bowel Syndrome (IBS)? Answer "Inflammatory bowel disease (IBD) is also associated with a higher risk of developing an inflammatory skin condition, such as psoriasis, atopic dermatitis, and rosacea. In one population-based cross-sectional study, the researchers found a significant association between IBD disorders, including both ulcerative colitis and Crohn’s disease, and inflammatory skin conditions. The same association was not found for autoimmune skin conditions, such as alopecia and vitiligo. In another study, the incident of IBD was higher in patients with rosacea compared to those without, with an adjusted hazard ratio of 1.94(95% CI 1.04 - 3.63 p= .04)." The Gut-Skin Axis: The Importance of Gut Health for Radiant Skin, Deanna Minich, Ph.D., Contributor, Huff Post A recent nationwide study in Taiwan has found an increased risk of inflammatory bowel disease (IBD) in people with rosacea, and of these, IBD was significantly more likely to occur in males. J Am Acad Dermatol. 2017 May;76(5):911-917. doi: 10.1016/j.jaad.2016.11.065. Epub 2017 Jan 7. Risk of inflammatory bowel disease in patients with rosacea: Results from a nationwide cohort study in Taiwan. Wu CY, Chang YT, Juan CK, Shieh JJ, Lin YP, Liu HN, Lin JT, Chen YJ. Etcetera IBS and Rosacea HLA-DRA Locus and Rosacea Gastrointestinal Rosacea [GR], aka, Gut Rosacea

The Rosacea Pipeline Insight, 2017 report covers the dormant and discontinued pipeline projects related to the Rosacea. The Rosacea Pipeline market Insight, 2017 report provides a complete understanding of the pipeline activities covering all clinical, pre-clinical and discovery stage products. Rosacea Pipeline Global Market Outlook, Product Description, Assessment by route of administration and Forecast Report, medGadget

Heather, welcome to the RRDi. Could be. Do you have a link that shows that Cetaphil is the base that Soolantra is made from? Note: Since this post, the RRDi has done an investigation into Cetaphil as the basis for vehicle with Soolantra. . Read this Post: Soolantra Mechanism of Action & Basis for the Vehicle

At least one type of bacteria is associated with demodex mites and rosacea. This bacteria is Bacillus oleronius according to an NRS press release [29] which quotes Dr. Kavanagh as saying, “This indicates that the Bacillus bacteria found in the Demodex mite produce an antigen that could be responsible for the tissue inflammation associated with papulopustular rosacea.” A study released in September 2007 by Dr. Frank Powell, et.al, also concluded, “Antigenic proteins related to a bacterium (B. oleronius), isolated from a D. folliculorum mite, have the potential to stimulate an inflammatory response in patients with papulopustular rosacea.” [30] Another study released in January 2010 also said, “The strong correlation provides a better understanding of comorbidity between Demodex mites and their symbiotic B oleronius in facial rosacea and blepharitis.” [31] A report by David Pascoe mentions another bacteria is associated with demodex, Bartonella quintana. [58] David also has an interesting article about demodex worth reading. [68] A third bacteria has been associated with demodex, Bacillus pumilus. [70] For more info see the end notes associated with the above at this article.

MENLO PARK, Calif., July 27, 2017 /PRNewswire/ -- BioPharmX Corporation (NYSE MKT: BPMX), a specialty pharmaceutical company developing products for the dermatology market, today announced that a panel of prominent dermatologists will discuss BPX-01, a unique topical hydrophilic gel formulation of minocycline at the 2017 AAD Summer Meeting tomorrow. BPX-01 is an investigational drug for the treatment of acne and rosacea. Summer AAD Panel to Discuss BPX-01 for Acne and Rosacea, NEWS PROVIDED BY BioPharmX Corporation, Cision, PR Newswire

Rosacea is considered the UK’s most common skin complaint. But what causes its red, itchy patches and how can you get rid of it? Why your diet could be causing rosacea, By Carla Challis, BT Carla doesn't mention sugar or carbohydrate as a rosacea trigger. The NRS still doesn't list sugar or carbohydrate as a rosacea trigger and articles like this one parrot the NRS trigger list.

Rosacea’s red cheeks and nose aren’t caused by heavy drinking, and nor is it down to poor hygiene. We dispel the myths surrounding this common skin condition. Rosacea: the causes and triggers of the skin condition explained, By Carla Challis, BT

Phenotype 6 - Ocular manifestations Ocular rosacea is common but often not recognized by the clinician.[1] It may precede, follow, or occur simultaneously with the skin changes typical of rosacea. In the absence of accompanying skin changes, ocular rosacea can be difficult to diagnose, and there is no test that will confirm the diagnosis. Patients usually have mild, nonspecific symptoms, such as burning or stinging of the eyes. A sensation of dryness is common, and tear secretion is frequently decreased. [2] Mild-to-moderate ocular rosacea (including blepharoconjunctivitis, chalazia, and hordeola) occurs frequently, whereas serious disease with the potential for visual loss, such as that which results from keratitis, occurs rarely. Ocular problems occur in at least 50 percent of patients with rosacea. [3] "Although considered a skin disease, rosacea may evolve the eyes in 58-72% of the patients, causing eyelid and ocular surface inflammation. About one third of the patients develop potentially sight-threatening corneal involvement. Untreated rosacea may cause varying degrees of ocular morbidity." [14] One report said, "Patients with rosacea have thinner corneas, which could be attributed to the observed deteriorated tear function parameters." [12] For images of Ocular Rosacea click here: http://goo.gl/ESG4n Links to get you started [5] Dry Eye: Awareness, Diagnosis, and Management All of the ocular rosacea articles at rosacea news Ocular Rosacea: Dr. Eric Jones, MD Ocular Rosacea: Dr. Mark J. Mannis, MD Ocular Rosacea: Curse of the Celts and Celebs, Heather Potter, MD, University of Wisconsin, School of Medicine and Public Health Treatment Astaxanthin along with some lutein and zeaxanthin "Dr Lange also likes to add 6 mg of astaxanthin along with some lutein and zeaxanthin in moderate to marked cases of blepharitis for the additional anti inflammatory properties when used together with omega 3." Natural Treatment for Blepharitis by Dr Michael Lange Avermectin Milbemycin Eyewash for Ocular Rosacea [7] Cliradex [15] Cyclosporine ophthalmic emulsion [22] Demodex mite treatment. [8] Intense pulsed light and low-level light therapy (IPL/LLLT) [20] IPL for DED " IPL therapy also reduces signs and symptoms of DED (Dry Eye Disease)." [17] Ivermectin [18] Optimel [16] Probiotics "There is an emerging understanding of the efficacy of probiotics, prebiotics, synbiotics and other functional foods on gut and local ocular microbiota in modulation of ocular inflammation and ocular surface health and homeostasis....Considering mechanisms of action derived from a microbiome-driven systemic or “holistic” approach to this disease might pave the way for a new generation of rigorous clinical studies to provide alternative and more effective solutions for management of DED." [19] Platelet-rich plasma (PRP) One report states, "We suggest that a clinically acceptable dosage of provides the ocular surface with the components necessary to restore normal cellular tensegrity and provides a foundation to eliminate the recurrence of the inflammation associated with DES [Dry eye syndrome]." [13] Treating ocular rosacea (from the AAO) Topical Cyclosporine Proves Beneficial For Ocular Rosacea [6] Terpinen-4-ol (T4O) Pass [11] [21] "A single or double application of ivermectin 1% cream is well tolerated and highly effective in reducing or eliminating the characteristic sleeves associated with Demodex blepharitis. The use of ivermectin 1% cream merits further investigation." [23] Diagnostic Test There may be a clinical diagnositic test now available for ocular rosacea. [4] One paper suggests, "The abundance of highly fucosylated N-glycans in the control samples and sulfated O-glycans in ocular rosacea patient samples may lead to the discovery of an objective diagnostic marker for the disease." [9] Another paper suggests, "The high abundance of oligosaccharides in the tear fluid of patients with rosacea may lead to an objective diagnostic marker for the disease." [10] "There is not yet a diagnostic test for rosacea. The diagnosis of ocular rosacea relies on observation of clinical features, which can be challenging in up to 90% of patients in whom accompanying roseatic skin changes may be subtle or inexistent." [14] End notes [1] Arch Dermatol 1997;133:89-90.[CrossRef][iSI] [Medline] Ocular rosacea: current concepts and therapy. Kligman AM [2] J Am Acad Dermatol 1992;26:211-214.[iSI] [Medline] Schirmer testing for dry eyes in patients with rosacea. Gudmundsen KJ, O'Donnell BF, Powell FC. [3] Rosacea: A Common, Yet Commonly Overlooked, Condition B. WAYNE BLOUNT, M.D., M.P.H. and ALLEN L. PELLETIER, M.D. Am Fam Physician. 2002 Aug 1;66(3):435-441. [4] Glycomics Analyses of Tear Fluid for the Diagnostic Detection of Ocular Rosacea Hyun Joo An, Milady Ninonuevo, Jennifer Aguilan, Hao Liu,‡ Carlito B. Lebrilla, Lenio S. Alvarenga, and Mark J. Mannis J. Proteome Res., 2005, 4 (6), pp 1981–1987, October 6, 2005, American Chemical Society Trail of Tears May Lead to the First Diagnostic Test for Ocular Rosacea Ocular Rosacea Test Updated: 6/21/2006 9:16:46 AM Dental Care & Health Care Articles [5] Link list courtesy of David Pascoe [6] Topical Cyclosporine Proves Beneficial For Ocular Rosacea Skin and Allergy News, Medical Dermatology BRUCE JANCIN, Skin & Allergy News Digital Network [7] Patent applied for by Galderma David Pascoe's comment on the above patent [8] In vitro and in vivo killing of ocular Demodex by tea tree oil. Gao YY, Di Pascuale MA, Li W, Baradaran-Rafii A, Elizondo A, Kuo CL, Raju VK, Tseng SC. Ocular Surface Center, 7000 SW 97 Avenue, Suite 213, Miami, FL 33173, USA. Br J Ophthalmol. 2005 Nov;89(11):1468-73. [9] Glycomic analysis of tear and saliva in ocular rosacea patients: the search for a biomarker. Vieira AC, An HJ, Ozcan S, Kim JH, Lebrilla CB, Mannis MJ. Ocul Surf. 2012 Jul;10(3):184-92. Epub 2012 May 3. [10] Glycomics Analyses of Tear Fluid for the Diagnostic Detection of Ocular Rosacea Hyun Joo An, Milady Ninonuevo, Jennifer Aguilan,Hao Liu, Carlito B. Lebrilla, Lenio S. Alvarenga,and Mark J. Mannis J. Proteome Res., 2005, 4 (6), pp 1981–1987, DOI: 10.1021/pr0501620, Publication Date (Web): October 6, 2005 [11] In clinical trials as of August 2012: Demodex Blepharitis Treatment Study (DBTS) [12] Can J Ophthalmol. 2012 Dec;47(6):504-8. doi: 10.1016/j.jcjo.2012.07.009. Central corneal thickness in patients with mild to moderate rosacea. Onaran Z, Karabulut AA, Usta G, Ornek K. [13] Optometry. 2012 Mar 30;83(3):111-3. Dry-eye--is inflammation just the tip of the iceberg? Jarka ES, Kahrhoff M, Crane JB. [14] Arq Bras Oftalmol. 2012 Oct;75(5):363-9. Ocular rosacea: a review. Vieira AC, Höfling-Lima AL, Mannis MJ. [15] One report on Cliradex is from yoegan on 5th April 2013 10:01 PM Post #467 [16] judworth [post no 6] says, "For those of you plagued by ocular rosacea (I have MGD) and very red and sore outer lash line, I have been using Optimel for just over 2 weeks, together with a cream cleanser Ilast and the results are very encouraging! I would say the above products have improved my issues by about 70% already (Optimel says improvement by 4 weeks)." [17] Clin Ophthalmol. 2017 Jun 20;11:1167-1173. doi: 10.2147/OPTH.S139894. eCollection 2017. Intense pulsed light for evaporative dry eye disease. Dell SJ. [18] Br J Dermatol. 2018 Mar 12. doi: 10.1111/bjd.16534. Successful therapy of ocular rosacea with topical ivermectin. Schaller M, Pietschke K. "To investigate the efficacy of once-daily topical treatment of ocular and cutaneous rosacea with ivermectin 1% cream (Soolantra®, Galderma)....Topical ivermectin cream 1% given daily is an effective and safe therapy against rosacea." Ocul Immunol Inflamm. 2020 Apr 07;:1-5 Efficacy of Topical Ivermectin for the Treatment of Cutaneous and Ocular Rosacea. Sobolewska B, Doycheva D, Deuter CM, Schaller M, Zierhut M [19] Antibiotics (Basel). 2019 Sep; 8(3): 88. The Case for a More Holistic Approach to Dry Eye Disease: Is It Time to Move beyond Antibiotics? Azadeh Tavakoli and Judith Louise Flanagan [20] Clin Ophthalmol. 2021; 15: 2133–2140. Combined Intense Pulsed Light and Low-Level Light Therapy for the Treatment of Dry Eye: A Retrospective Before–After Study with One-Year Follow-Up Miguel Angel Pérez-Silguero, David Pérez-Silguero, Amado Rivero-Santana, Maria Inmaculada Bernal-Blasco, Pablo Encinas-Pisa [21] Successful management of chronic Blepharo-rosacea associated demodex by lid scrub with terpinen-4-ol Han Y. Yin, Sean Tighe, Scheffer CG. Tseng, Anny MS. Cheng Am J Ophthalmol Case Rep. 2021 Sep; 23: 101171. Published online 2021 Jul 22. doi: 10.1016/j.ajoc.2021.101171 [22] Skin Therapy Lett. 2021 Jul;26(4):1-8. Rosacea: An Update in Diagnosis, Classification and Management Cindy Na-Young Kang, Monica Shah, Jerry Tan [23] Am J Ophthalmol Case Rep. 2022 Jun; 26: 101551. Treatment of ocular Demodex infestation with topical ivermectin cream Craig J. Helm

CocaCola has announced a new Coke Zero Sugar brand (a different formula from Coke Zero) today which has been marketed in other countries and will be now marketed in the USA. For you CocaCola lovers who want to avoid sugar you may want to try it out. CocaCola will be eventually dropping Coke Zero from its line of products replace it with Coke Zero Sugar. Read this in the Los Angeles Times. I have listed for your convenience the ingredients of Diet Coke, Coke Zero, and Coke Zero Sugar if you are interested in knowing: Diet Coke Ingredients: Carbonated Water, Caramel Color, Aspartame, Phosphoric Acid, Potassium Benzoate (To Protect Taste), Natural Flavors, Citric Acid, Caffeine. Coke Zero (no longer available) Ingredients: Carbonated Water, Caramel Color, Phosphoric Acid, Aspartame, Potassium Benzoate (To Protect Taste), Natural Flavors, Potassium Citrate, Acesulfame Potassium, Caffeine. Coke Zero Sugar Ingredients: Water, Colour (Caramel E150d), Phosphoric Acid, Sweeteners (Aspartame, Acesulfame K), Natural Flavourings Including Caffeine, Acidity Regulator (Sodium Citrate). Contains a Source of Phenylalanine

The Healthy Geezer: Red, bumpy nose is rosacea, not booze, By Fred Cicetti, Times Herald-Record

Phymatous (Rhinophyma) [aka Subtype 3] No current consensus exists on the ideal surgical treatment as the option chosen largely depends on the combined decision of the patient and provider based on cost, disease severity, and experience of the provider. We list the treatments being used below for your consideration. This phenotype responds to treatment very well. Phymatous rosacea is uncommon. The most frequent phymatous manifestation is rhinophyma (known familiarly as "whiskey nose" "brandy nose" or "rum blossom"). In its severe forms, rhinophyma is a disfiguring condition of the nose resulting from hyperplasia of both the sebaceous glands and the connective tissue. Rhinophyma occurs much more often in men than in women (approximate ratio, 20:1), [1] and a number of clinicopathologic variants have been described. [2] Although rhinophyma is often referred to as "end-stage rosacea," [30] "fourth stage rosacea," [30] "stage III rosacea," [29] or "the most advanced stage of rosacea" [27], it may occur in patients with few or no other features of rosacea. The diagnosis is usually made on a clinical basis, but a biopsy may be necessary to distinguish atypical or nodular rhinophyma from lupus pernio (sarcoidosis of the nose); basal-cell, squamous-cell, and sebaceous carcinomas; angiosarcoma; and even nasal lymphoma. [3] Older papers usually mention how rosacea progresses in stages and ends up in subtype 3 (Phenotype 5), but recent studies indicate that this is not necessarily true. One can develop phenotype 5 without going through any 'stages.' [read this post] One report says, "It can affect nose (rhinophyma), chin (gnatophyma), forehead (metophyma), ears (otophyma) and eyelids (blepharophyma). Rhinophyma is the most frequent location..." [15] For images of phenotype 5 (formerly Subtype 3) click below: http://goo.gl/BI2lf; 28 Images of Rhinophyma A classic example of Phenotype 5 is WC Fields (the rosacea poster boy) Another classic example is this painting in the Louvre, "The Old Man and His Grandson" by Ghirlandiao around the year 1480. There are Five Variants of Rhinophyma: Glandular Fibrous FibroangiomatousActinic Rhinophymous leishmaniasis This is a great thread to read about Subtype 3. Otophyma Treatment "No current consensus exists on the ideal surgical treatment as the option chosen largely depends on the combined decision of the patient and provider based on cost, disease severity, and experience of the provider." [32] "At present, the treatment of this pathology presents great difficulties. Despite the many surgical methods, rhinophyma is poorly treatable, often relapses and leaves no less noticeable disfigurement of the face in the postoperative period. In this regard, there is a constant search for new surgical methods, which has not only medical but also important social significance." [33] There are a number of different treatments for rhinophyma, including surgery, but it is better to treat the rosacea before it reaches the advance stage of rhinophyma. However, once rhinophyma has developed it can usually be corrected by surgery using either laser, scapel, or dermabrasion. The good thing about rhinophyma is that though this condition is generally regarded as a severe form of rosacea it is a relatively rare disorder involving thickening of the skin on the nose and the presence of many oil glands and this condition can usually can be corrected. Accutane is usually the drug of choice, but your physician may use other prescription drugs such as antibiotics if you have this skin disorder. This report said, "Despite many advances in fundamental understanding, surgical techniques, and related technologies, no single method has been universally embraced and employed as the 'gold standard.' " [11] Other treatment may involve cryosurgery, dermashaving and electrosurgery. Below is a list you can consider and ask your physician about: Acellular dermal matrix [26] Autologous Melanocyte Transplantation for those with Fitzpatrick skin type IV-VI CO2 Laser (or other laser) One reports says, "The CO2 laser is more capital intensive and results in higher fees compared with the simpler cold blade tangential excision. In our experience the ease of use, accuracy and precision of the lasers offer is not justified by the increased costs." [20] 1064 nm Q-Switched Neodymium:Yttrium Aluminum Garnet Laser Another report says, "Both tangential excision and carbon dioxide laser are well-established, reliable procedures for rhinophymaplasty that preserve the underlying sebaceous gland fundi allowing spontaneous re-epithelialization without scarring with similar outcomes and high patient satisfaction. The original nose shape and nearly normal skin surface texture are preserved by quickly removal of the hypertrophic tissue sparing the pilosebaceous tissue. The CO(2) laser is more capital intensive and results in higher fees compared with the simpler cold blade tangential excision. In our experience the ease of use, accuracy and precision of the lasers offer is not justified by the increased costs." [16] "Coblation of rhinophyma is an effective treatment with few side effects." [4] Another treatment has been reported, coblation. The report says, "A hand-held coblation ‘wand’ emits a slow stream of saline solution – sterilised salt water – from the end that comes into contact with the nose. At the same time, it emits waves of radiofrequency energy to excite the molecules in the solution which ‘sands’ down the tissue. It also uses a low heat to cauterise (clot) any bleeding blood vessels." [12] Fractional ablative CO2 laser treatment ultra plus CO2 laser Fractional ablative 2940 nm Er:YAG laser [31] Fractional or fully ablative CO2 laser alone or in combination with oral isotretinoin is a very effective treatment modality. Copper Vapor Laser With the Computerized Scanner [27] Laser-assisted surgery and bioscaffold Erbium-doped Yttrium Aluminium Garnet (Er:YAG) Laser Optimizing wound healing and cosmesis of surgical closures on rhinophymatous skin Cryotherapy Cryotherapy is listed among other treatments for phenotype 5. [23] Dermabrasion "Our technique combining dermabrasion, decortication and application of fibrin glue has given very good results." [21] Electrocautery Electrocautery [28] Electrocautery [34] Excison Excision and repair with bilateral pedicled nasolabial flaps [25] Microdebrider-assisted excision Surgical Excision and Amniotic Membrane [24] Hydrosurgery Low Dose Isotretinoin Ordinary Bur Radiofrequency is used to treat rhinophyma. [6] Radiosurgical excision of rhinophyma. [9] Rhinophyma treated with kilovoltage photons [7] Scapel Scalpel Excision and Wire Loop Tip Electrosurgery [19] "This report describes a simple, safe, efficient, and cost-effective approach to the treatment of severe rhinophyma using a scalpel and the electroscalpel, instruments readily available in every operating room." [18] Shave excision [34] Shave excision and Electrocautery "Surgery is indisputably the treatment of choice for rhinophyma." [10] [28] Five-blades scratcher surgery "We conclude that the microdebrider is an excellent surgical tool for treating rhinophyma lesions." [22] Steroid Treatment "...Initially, the mass was thought to be rhinophyma, but biopsy of the mass revealed noncaseating granulomata consistent with sarcoidosis. The mass resolved following several steroid injections..." [5] Smoothbeam laser [13] Surgical Management [14] [28] Ultrasonic Scapel Treatment of rhinophyma with ultrasonic scalpel: case report [8] Another report, which says, "a surgical "gold standard" for treating the distorting phymatous skin alterations has not yet been established," it goes on to state, "the combination of a bovine collagen-elastin with simultaneous autologous non-meshed split-thickness skin grafting" was used in a surgery, and "may ultimately avoid the recurrence of rhinophyma and contribute to a full skin repair leading to satisfactory functional and aesthetic outcome." [17] Salicylic acid 30% • Jojoba oil • Glycolic acid 70% • Baking Soda • Dawn Ultra Anecdotal Reports Nose Swelling, big pores, phymous tissue--please post! End Notes [1] Roberts JO, Ward CM. Rhinophyma. J R Soc Med 1985;78:678-681.[iSI] [Medline] [2] Aloi F, Tomasini C, Soro E, Pippione M. The clinicopathologic spectrum of rhinophyma. J Am Acad Dermatol 2000;42:468-472.[CrossRef][iSI] [Medline] [3] Murphy A, O'Keane JC, Blayney A, Powell FC. Cutaneous presentation of nasal lymphoma: a report of two cases. J Am Acad Dermatol 1998;38:310-313.[iSI] [Medline] [4] Coblation of rhinophyma. Timms M, Roper A, Patrick C.J Laryngol Otol. 2011 Apr 27:1-5. [5] Sarcoidosis of the external nose mimicking rhinophyma. Case report and review of the literature. Goldenberg JD, Kotler HS, Shamsai R, Gruber B.Ann Otol Rhinol Laryngol. 1998 Jun;107(6):514-8. [6] Management of mild to moderate rhinophyma with a radiofrequency. Erisir F, Isildak H, Haciyev Y.J Craniofac Surg. 2009 Mar;20(2):455-6. [7] Rhinophyma treated with kilovoltage photons. Skala M, Delaney G, Towell V, Vladica N.Australas J Dermatol. 2005 May;46(2):88-9. [8] Treatment of rhinophyma with ultrasonic scalpel: case report. Tenna S, Gigliofiorito P, Langella M, Carusi C, Persichetti P.J Plast Reconstr Aesthet Surg. 2009 Jun;62(6):e164-5. Epub 2008 Dec 12. [9] Radiosurgical excision of rhinophyma. Somogyvári K, Battyáni Z, Móricz P, Gerlinger I.Dermatol Surg. 2011 May;37(5):684-7. doi: 10.1111/j.1524-4725.2011.01965.x. Epub 2011 Apr 1. Letter: radiosurgical excision of rhinophyma. Niamtu J 3rd.Dermatol Surg. 2012 May;38(5):816-7. doi: 10.1111/j.1524-4725.2012.02383.x. [10] Rhinophyma in rosacea : What does surgery achieve? Sadick H, Riedel F, Bran G.Hautarzt. 2011 Oct 19. [11] Nuances in the management of rhinophyma. Facial Plast Surg. 2012 Apr;28(2):231-7Authors: Little SC, Stucker FJ, Compton A, Park SS [12] How salt-blasting surgery cured my disfiguring condition called 'drinker's red nose' By ROGER DOBSON Mail Online / Health PUBLISHED: 16:07 EST, 12 May 2012 | UPDATED: 17:23 EST, 12 May 2012 Read more: http://www.dailymail...l#ixzz1uvARY8Et [13] J Dermatolog Treat. 2012 Apr;23(2):153-5. Epub 2010 Oct 22. Moderate rhinophyma successfully treated with a Smoothbeam laser. Chou CL, Chiang YY [14] Conn Med. 2014 Mar;78(3):159-60. Surgical management of rhinophyma: a case report and review of literature. Ferneini EM, Banki M, Paletta F, Ferneini CM. [15] An Bras Dermatol. 2012 Dec;87(6):903-5. Gnatophyma: a rare form of rosacea. Macedo AC, Sakai FD, Vasconcelos RC, Duarte AA. [16] J Craniomaxillofac Surg. 2012 Dec 8. pii: S1010-5182(12)00248-X. doi: 10.1016/j.jcms.2012.11.009. Surgical correction of rhinophyma: Comparison of two methods in a 15-year-long experience. Lazzeri D, Larcher L, Huemer GM, Riml S, Grassetti L, Pantaloni M, Li Q, Zhang YX, Spinelli G, Agostini T. [17] Int J Surg Case Rep. 2012 Nov 10;4(2):200-203. doi: 10.1016/j.ijscr.2012.11.003. [Epub ahead of print] The surgical treatment of rhinophyma-Complete excision and single-step reconstruction by use of a collagen-elastin matrix and an autologous non-meshed split-thickness skin graft. Selig HF, Lumenta DB, Kamolz LP. Aesthetic Plast Surg. 2013 Jan 8. [Epub ahead of print] Optimizing Cosmesis with Conservative Surgical Excision in a Giant Rhinophyma. Lazzeri D, Agostini T, Spinelli G. [18] Aesthetic Plast Surg. 2013 Mar 1. [Epub ahead of print] Management of Severe Rhinophyma With Sculpting Surgical Decortication. Husein-Elahmed H, Armijo-Lozano R. [19] Dermatol Surg. 2013 Apr 5. doi: 10.1111/dsu.12193. [Epub ahead of print] Treatment of Severe Rhinophyma Using Scalpel Excision and Wire Loop Tip Electrosurgery. Prado R, Funke A, Brown M, Ramsey Mellette J. Source Northeast Dermatology Associates, Andover, Massachusetts. [20] J Craniomaxillofac Surg. 2013 Jul;41(5):429-36. doi: 10.1016/j.jcms.2012.11.009. Epub 2012 Dec 8. Surgical correction of rhinophyma: comparison of two methods in a 15-year-long experience. Lazzeri D1, Larcher L, Huemer GM, Riml S, Grassetti L, Pantaloni M, Li Q, Zhang YX, Spinelli G, Agostini T. [21] Rhinophyma: Our experience based on a series of 12 cases. Eur Ann Otorhinolaryngol Head Neck Dis. 2017 Sep 21;: Clarós P, Sarr MC, Nyada FB, Clarós A [22] Use of the microdebrider in the surgical management of rhinophyma. Ear Nose Throat J. 2018 Jan-Feb;97(1-2):E42-E45 Chow W, Jeremic G, Sowerby L [23] Aesthetic Plast Surg. 2004 Dec 23; The Gold Standard for Decortication of Rhinophyma: Combined Erbium- YAG/CO(2) Laser. Goon PK, Dalal M, Peart FC. Department of Plastic Surgery, University Hospital Birmingham, Selly Oak, West Midlands, Birmingham, United Kingdom Rhinophyma is a benign condition of the nose that often is severely disfiguring and occasionally causes functional problems. A considerable proportion of the patients, with rhinophyma are elderly with chronic medical problems. Electrocautery, heated scalpel, carbon dioxide (CO(2)) laser, argon laser, Weck blade, dermabrasion, cryotherapy, radiotherapy, full-thickness excision, skin graft, flap reconstruction, and cold scalpel have been used either alone or in combination. All these techniques have disadvantages that are resolved by using the combined erbium:yttrium-aluminum-garnet (YAG)/CO(2) laser. The authors present their technique and the results from decortication of rhinophyma using a combined erbium:YAG/CO(2) laser. The technique requires only local anesthesia with a vasoconstrictor. The combination of an efficient vaporization tool consisting of the erbium:YAG laser and the CO(2) coagulation laser provides a nearly bloodless field for accurate sculpting of the nose and produces cosmetically pleasing results. [24] J Craniofac Surg. 2019 Apr 10;: Treatment of Rhinophyma With Surgical Excision and Amniotic Membrane. Yoo JJ, Thaller SR [25] J Craniofac Surg. 2019 Apr 12;: Surgical Treatment Strategy for Severe Rhinophyma With Bilateral Pedicled Nasolabial Flaps. Cui MY, Guo S, Wang CC, Lv MZ, Jin SF [26] Int J Surg Case Rep. 2019; 59: 120–123. Acellular dermal matrix for rhinophyma: Is it worth it? A new case report and review of literature Matteo Torresetti, Alessandro Scalise, and Giovanni Di Benedetto [27] J Lasers Med Sci. 2019 Spring; 10(2): 153–156. Rhinophyma Treatment by Copper Vapor Laser With the Computerized Scanner Igor V. Ponomarev, Sergey B. Topchiy, Svetlana V. Klyuchareva, Alexandra E. Pushkareva [28] Case Rep Surg. 2019; 2019: 2395619. Large Rhinophyma Treated by Surgical Excision and Electrocautery Nabeel K. Al Hamzawi and Salih M. Al Baaj [29] Case Rep Otolaryngol. 2019;2019:4915416 Microdebrider-Assisted Rhinophyma Excision. Abushaala A, Stavrakas M, Khalil H [30] Does Rosacea Progress In Stages? [31] Clin Cosmet Investig Dermatol. 2020; 13: 949–955. Novel Management of Rhinophyma by Patterned Ablative 2940nm Erbium:YAG Laser Ashraf Badawi, Mai Osman, and Ahmed Kassab [32] StatPearls [Internet]. Rhinophyma Mary K. Dick; Bhupendra C. Patel. [33] The rhinophyma through the prism of time [34] BMJ Case Rep. 2020; 13(1): e232973. Severe rhinophyma treated by shave excision and electrocautery Manish Gupta, Gurchand Singh, and Monica Gupta

Face flushing? You might want to look at what you’re drinking: Alcohol can raise your risk of a skin condition called rosacea, a new study published in the Journal of the American Academy of Dermatology suggests. In the study, researchers quizzed nearly 83,000 people on their alcohol intake every four years. They discovered that the more total alcohol they drank, the more likely they were to develop rosacea over the 14-year follow up. How Booze Can Make Your Face Red, Flushed, and Swollen, BY CHRISTA SGOBBA, Men's Health Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. If you never heard about this topic and you learned about it here first, wouldn't it be a gracious act on your part to show your appreciation for this topic by registering with just your email address and show your appreciation with a post? And if registering is too much to ask, could you post your appreciation for this topic by finding the START NEW TOPIC button in our guest forum where you don't have to register? We know how many have viewed this topic because our forum software shows the number of views. However, most rosaceans don't engage or show their appreciation for our website and the RRDi would simply ask that you show your appreciation, please, simply by a post.

Gold Standard In an interview with Linda Stein Gold, MD, Soolantra Cream Clinical Investigator, who also volunteers on the RRDi MAC, explains Soolantra's benefits. Dr. Stein Gold says, "I see topical ivermectin therapy as first line therapy for Papulopustular Rosacea" and is considered part of the gold standard treatment for rosacea. Other prescription treatments Permethrin 5% Cream Oral ivermectin Benzyl Benzoate and Crotamiton Epsolay Non prescription The ZZ cream is an excellent non prescription treatment to consider as well for Phenotype 4. Other non prescription treatments Demodex Solutions Treatments Other non prescription Horse paste